At a recent La Leche League Meeting, parents traded stories about tongue ties. One mother explained how the lactation consultant in the hospital had said her latch looked perfect, but then once they got home, baby wasn’t making enough wet and dirty diapers. Another mom mentioned how her baby was gaining great but that her nipples always hurt. When she unlatched, her nipple was misshapen and often had a white tip. One couple explained how their daughter’s latch would start off “perfect” and then slip as they fed so that it was very shallow. They had all searched the internet and had come asking the same thing. Could it be a tongue tie?

Breastfeeding challenges can occur for many reasons. If you’d like help trouble shooting, contact your local LLL Leader.

What is a tongue tie?

A tongue-tie is an unusually short, thick, or tight band of tissue that tethers the bottom of the tongue to the the floor of the mouth, inhibiting a full range of motion. There are both anterior (tip of tongue) and posterior (back of tongue) tongue ties and both may make breastfeeding more difficult.

Can tongue ties and lip ties affect breastfeeding? How?

Many parents have found that tongue and lip ties (also called oral restrictions) affected breastfeeding by affecting how their baby was able to latch–or causing their baby to not latch at all.

Families report a range of potential symptoms that may include:

• Nipple pain at latch on and sometimes throughout the nursing session
• Nipple trauma such as blisters, cracks, creases, misshapen “lip stick shaped” nipples after nursing, scabs
• A good latch “slipping” to a shallow latch as the baby nurses, sometimes leading to Popping on and off the nipple frequently
• Leaking milk out the side of the mouth
• Clicking sound while nursing indicating a shallow or ineffective latch
• Frequent plugged ducts

In baby, they include:

• Low or slow weight gain
• Gumming, chewing, or clamping down on nipples rather than rhythmic sucking
• Inability to lift the tongue from the base of the mouth, sometimes making the tongue look heart shaped while crying
• Fatigue and falling asleep at the breast before baby is full
• Gassiness, colic, or reflux symptoms from extra air being swallowed during feedings

What can help?

There are several things that can lead to improvement for the nursing pair.

Special attention to positioning. Some nursing parents have noticed that paying special attention to positioning can help them nurse often with less discomfort. These can include:

• Using a c hold to get as much breast tissue in the baby’s mouth as possible
• Laid back breastfeeding which can use gravity to help baby achieve a deeper latch

An LLL Leader can assist you in positioning to see if you can achieve a pain-free latch.

Body work. Some families have found that body work including chiropractic, massage, and craniosacral therapy (CST) have helped release tension in the nursling and ease breastfeeding pain associated with tongue ties and lip ties.

Revising tongue and lip ties. Some families choose to have their children’s tongue ties revised. Read more on this below.

Who can diagnose a tongue tie? 

Tongue-tie is typically diagnosed during a physical exam. Tongue ties are sometimes diagnosed during a baby’s routine newborn check, but it’s not always easy to spot. It may not become apparent until later when problems have arisen. Once a tongue tie is suspected, it’s important to find someone who is knowledgeable about both tongue ties and how they interact with breastfeeding. This may be a pediatrician, dentist, oral surgeon, or an otolaryngologist (ENT). An IBCLC cannot diagnose a tongue tie, but they can evaluate and refer to another healthcare provider for diagnosis. LLL Leaders as parent-to-parent support volunteers are unable to diagnose tongue ties. We are able to share information and help you with next steps if you suspect a tongue tie.

How does a tongue tie revision work?

Tongue ties are revised (corrected) surgically. Also called a frenotomy, the procedure is usually done by an otolaryngologist (ENT) or pediatric dentist but is also done by some pediatricians. The provider will usually do a physical evaluation of the tongue and mouth and may also do a functional evaluation to see how the baby nurses. The provider may also suggest seeing an IBCLC for a more thorough functional evaluation before or after the procedure to insure that there are not other possible breastfeeding issues.

Does a tongue tie have to be corrected to breastfeed?

While many families choose to have their nursling’s ties revised, others do not for several reasons including worry about the procedure being painful for baby, uncertainty over the procedure’s effectiveness, or financial reasons such as not being able to afford the out-of-pocket cost or health insurance not covering the procedure. LLL Leaders are available to help you as you weigh your options.

RESOURCES

Sore Nipples, LLL USA

Low Milk Supply, LLL USA

Positioning and Latching, LLL USA

Tongue-tie (ankyloglossia), Mayo Clinic

Breastfeeding a Baby with Tongue-Tie or Lip-Tie, KellyMom

A Tongue Restriction Isn’t Always a Tongue Tie, Carol Smyth, IBCLC

Tongue Tie, La Leche League GB

PERSONAL STORIES

What can I do about my baby’s tongue tie, LLL USA Facebook

My baby had his tongue tie revised and still isn’t nursing better, LLL USA Facebook

Liz’s Story: Struggles with Tongue-Tie and Weight Gain, LLL USA blog

Katelyn’s Story: Overcoming mastitis and tongue-tie, LLL USA blog

Breastfeeding is My Superpower, LLL USA blog

My Grandmother’s Breastfeeding Legacy: Never Give Up, LLL USA blog

Rest Is Best, LLL USA blog

IS YOUR CONCERN OR QUESTION NOT COVERED HERE?

Please contact a local LLL Leader with your specific questions.

Medical questions and legal questions should be directed to appropriate health care and legal professionals.

Page updated March 2020